- Humana (Columbus, OH)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of… more
- Randstad US (Dallas, TX)
- medical appeals and denials specialist. + dallas , texas + posted 2 days ago **job details** summary + $20 - $20.93 per hour + temp to perm + high school + ... category office and administrative support occupations + referenceAB_4525137 job details If you...further. Must have at least 2 years of backend appeals and denials experience. salary: $20 - $20.93 per… more
- Actalent (Dayton, OH)
- …Hearing and completed all required compliances. * Complete required compliances for Administrative Hearing decisions * Apply CareSource Medical Policy and ... License Description: * Responsible for the completion of clinical appeals and state hearings from all states * Review...clinical appeals . * Refer denials based on medical necessity to medical director. * Maintain… more
- Robert Half Accountemps (Los Angeles, CA)
- …all collection efforts per company policies/procedures. Requirements Medical Billing, Medical Collections, Medical Appeals , Medical Denials, ... Central Business Office is in the need of a Medical Insurance Collections Specialist. The Medical Insurance...to determine collection activities and processes. + Submits timely appeals and follows up on claims at various stages… more
- CVS Health (Springfield, IL)
- …of most days completing assigned medication utilization reviews (PA) and/or medical necessity appeals for commercial clients, governmental (Medicare/Medicaid) ... programs and individual client requested coverage determinations or appeals when appropriate.- Medical Directors will participate in inter-rater review… more
- Providence (Seattle, WA)
- …divisional pre-service and post-service utilization review, clinical claims audit, clinical appeals and reconsiderations, medical policy, and program management. ... **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus on… more
- Robert Half Accountemps (Los Angeles, CA)
- …in a timely manner. Requirements Medical software, Medical Billing, Medical Collections, Medical Appeals , Medical Denials, Hospital Billing, ... Hospital Business Office is currently seeking a dedicated and detail-oriented Medical Billing Collection Specialist. The successful candidate will be responsible for… more
- TEKsystems (Indianapolis, IN)
- …administrative support Top Skills Details: data entry, medical terminology,insurance coverage,patient registration,insurance billing,insurance follow up, appeals ... insurance coverage, patient registration, insurance billing, insurance follow up, appeals , medical record, claims resolution, denied claims, medicaid,… more
- TEKsystems (Mcgregor, TX)
- …insurance coverage, patient registration, insurance billing, insurance follow up, appeals , medical record, open enrollment, claims resolution, denied ... entry,Insurance verification,Health care, Medical , Medical billing,Health insurance,medicare,claim,insurance companies, medical terminology,insurance coverage,patient registration,insurance billing,insurance follow up, appeals … more
- Commonwealth of Pennsylvania (PA)
- …responsibility designated by the Secretary of Human Services for the adjudication of administrative appeals for the Department of Human Services and the ... hearings such as, but not limited to: formal appeals , recipient appeals (SNAP, cash assistance, medical assistance, etc.) and non-recipient appeals … more
- Robert Half Accountemps (Rochester, NY)
- … medical coding standards to perform billing functions, claim administration , and collection processes. Responsibilities: * Utilize accounting software systems ... * Experience in Accounts Receivable (AR) * Knowledge of Appeals process in medical billing * Proficiency...* Proficiency in Billing Functions * Knowledge of Claim Administration * Familiarity with Collection Processes * Proficiency in… more
- Robert Half Accountemps (Fort Wayne, IN)
- …execution of tasks. * Manage Insurance Denials and Payer Denials, and handle Medical Appeals . * Leverage expertise in Insurance Follow-up, Claim Denials, Denial ... * Experience in handling Payer Denials * Knowledge of Medical Appeals process * Familiarity with Claim...finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to… more
- Robert Half Accountemps (Plano, TX)
- …well as paid vacation and paid holidays. Requirements * Proficiency in handling Appeals related to medical billing. * Experience with various Billing Functions ... Our client in the Plano area is seeking multiple Medical Billing Specialists to add to their growing staff...(ie, Epic or AMD) + Someone with experience with appeals and follow-ups is a big preference + Strong… more
- Robert Half Accountemps (Long Beach, CA)
- …plus but not a must Requirements Medical Billing, Medical Collections, Medical Denials, Medical Appeals , Behavioral Health, Medi-Cal, HMO PPO Robert ... you motivated, with attention to detail? This growing company is hiring a Medical Collections Specialist with strong behavioral health skills. The Medical … more
- WMCHealth (Valhalla, NY)
- …to discuss cases and problems. + Participates in daily review of aggregate denials/ appeals with the Medical Director, peer, or the Clinical Review Supervisor. ... is responsible for developing positive relationships with both employed and affiliated medical staff members in order to fulfill strategic business growth and… more
- Point32Health (Canton, MA)
- …standards + The Director's other tasks include: + Develop and maintain the administrative budget for the Appeals and Grievances Department + Participate in ... . **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and oversight of the… more
- Universal Health Services (Reno, NV)
- …Services (UHS). We offer HMO, PPO, and Medicare Advantage plans, Administrative Services for self-funded organizations, and Accountable Care Organization (ACO) ... administration and consulting. We started in Northern Nevada in...Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review,… more
- Actalent (Dayton, OH)
- …Hearing and completed all required compliances. * Complete required compliances for Administrative Hearing decisions * Apply company Medical Policy and Milliman ... We are currently hiring for a Clinical Appeals Nurse in a fully REMOTE role! A...administrative denials appropriately. * Refer denials based on medical necessity to medical director. * Maintain… more
- State of Indiana (Indianapolis, IN)
- …tools and work items in the database for the appropriate agency unit. + Appeals : Provides administrative and clerical support to the Administrative Law ... Appeals Law Clerk Date Posted: Apr 19, 2024...at least 4 years of full-time professional experience in administrative support, business administration , program support, public… more
- CVS Health (Fresno, CA)
- …between 9am-1pm. Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more